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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Comparison of Home-Based vs Center-Based Cardiac Rehabilitation in Hospitalization, Medication Adherence, and Risk
Chileshe Nkonde-Price1,2,3,4, Kristi Reynolds3,5, Michael Najem2
1Department of Cardiology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California.
Insights
Home-based cardiac rehabilitation (HBCR) showed lower 12-month hospitalization rates compared to center-based cardiac rehabilitation (CBCR) in diverse, medically complex patients. This study supports HBCR for understudied populations.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Prior studies suggest similar clinical outcomes between home-based cardiac rehabilitation (HBCR) and center-based cardiac rehabilitation (CBCR) for low-to-moderate risk patients.
- Limited outcome data exists for demographically diverse populations and medically complex patients undergoing cardiac rehabilitation.
- Home-based cardiac rehabilitation offers a potential alternative for patients unable to attend center-based programs.
Purpose of the Study:
- To compare hospitalizations, medication adherence, and cardiovascular risk factor control between HBCR and CBCR participants.
- To evaluate the effectiveness of HBCR in a demographically diverse and medically complex patient cohort.
- To provide evidence supporting the use of HBCR in understudied populations.
Main Methods:
- Retrospective cohort study of patients participating in cardiac rehabilitation (CR) within an integrated health care system.
- Inclusion criteria: CR participation between April 2018-April 2019 with 12-month follow-up.
- Primary outcome: 12-month all-cause hospitalization. Secondary outcomes: shorter-term hospitalizations, medication adherence, and cardiovascular risk factor control. Inverse probability treatment weighting (IPTW) was used for analysis.
Main Results:
- The study included 2556 patients, with 48.5% receiving HBCR and 51.5% receiving CBCR. The cohort was diverse, with 46.8% having a Charlson Comorbidity Index ≥4.
- After IPTW, HBCR participants had significantly lower odds of 12-month hospitalization (OR, 0.79; 95% CI, 0.64-0.97).
- No significant differences were observed in adherence to beta-blockers or statins, or control of blood pressure, LDL cholesterol, or HbA1c between HBCR and CBCR groups at 12 months.
Conclusions:
- Home-based cardiac rehabilitation was associated with reduced 12-month hospitalizations in a demographically diverse and medically complex patient population.
- These findings support the expanded use of HBCR, particularly for populations historically underrepresented in cardiac rehabilitation research.
- HBCR demonstrates comparable effectiveness to CBCR in managing cardiovascular risk factors and medication adherence.
Importance:
Prior studies have suggested that participation in home-based cardiac rehabilitation (HBCR) vs center-based cardiac rehabilitation (CBCR) results in similar clinical outcomes in patients with low to moderate risk; however, outcome data from demographically diverse populations and patients who are medically complex are lacking.
Objective:
To compare hospitalizations, medication adherence, and cardiovascular risk factor control between participants in HBCR vs CBCR.
Design, Setting, And Participants:
This retrospective cohort study was conducted among patients in Kaiser Permanente Southern California (KPSC), an integrated health care system serving approximately 4.7 million patients, who participated in CR between April 1, 2018, and April 30, 2019, and with follow-up through April 30, 2020. Data were analyzed from January 2021 to January 2022.
Exposures:
Participation in 1 or more HBCR or CBCR sessions.
Main Outcomes And Measures:
The primary outcome was 12-month all-cause hospitalization. Secondary outcomes included all-cause hospitalizations at 30 and 90 days; 30-day, 90-day, and 12-month cardiovascular hospitalizations; and medication adherence and cardiovascular risk factor control at 12 months. Logistic regression was used to compare hospitalization, medication adherence, and cardiovascular risk factor control, with inverse probability treatment weighting (IPTW) to adjust for demographic and clinical characteristics.
Results:
Of 2556 patients who participated in CR (mean [SD] age, 66.7 [11.2] years; 754 [29.5%] women; 1196 participants [46.8%] with Charlson Comorbidity Index ≥4), there were 289 Asian or Pacific Islander patients (11.3%), 193 Black patients (7.6%), 611 Hispanic patients (23.9%), and 1419 White patients (55.5%). A total of 1241 participants (48.5%) received HBCR and 1315 participants (51.5%) received CBCR. After IPTW, patients who received HBCR had lower odds of hospitalization at 12 months (odds ratio [OR], 0.79; 95% CI, 0.64-0.97) but similar odds of adherence to β-blockers (OR, 1.18; 95% CI, 0.98-1.42) and statins (OR, 1.02; 95% CI, 0.84-1.25) and of control of blood pressure (OR, 0.98; 95% CI, 0.81-1.17), low-density lipoprotein cholesterol (OR, 0.98; 95% CI, 0.81-1.20), and hemoglobin A1c (OR, 0.98; 95% CI, 0.82-1.18) at 12 months compared with patients who received CBCR.
Conclusions And Relevance:
These findings suggest that HBCR in a demographically diverse population, including patients with high risk who are medically complex, was associated with fewer hospitalizations at 12 months compared with patients who participated in CBCR. This study strengthens the evidence supporting HBCR in previously understudied patient populations.
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